Acute scrotum in the setting of acute necrotizing pancreatitis: a surprise

Abstract

A 38-year-old male patient had a prior admission for alcoholinduced acute necrotizing pancreatitis, which was managed conservatively with intravenous antibiotics and pigtail drainage of the intra-abdominal collections and later discharged. The patient presented a month later with high-grade fever, severe epigastric pain radiating to the back and pain with swelling in the scrotum. On examination, the patient was febrile. There was epigastric tenderness and examination of the genitalia revealed scrotal oedema, erythema, raised local temperature and exquisite tenderness on the right side. A sonogram revealed scrotal wall oedema, with normal bilateral testis and intact vascularity, the right epididymis was bulky and there was a collection in the right hemiscrotum. A contrastenhanced computed tomogram of the abdomen and pelvis demonstrated multiple pancreatic and peripancreatic collections that made their way along the retroperitoneum into the scrotum along the right spermatic cord (Fig. 1). Pigtail drainage of the collections was performed. The collections were infected as revealed by the positive cultures from the pus aspirated. The cultured organism was Escherichia coli and the patient was started on parenteral antibiotics (cefoperazone–sulbactum) as per sensitivity reports. The scrotal signs disappeared and the pain subsided. The patient improved and was later discharged in satisfactory condition. Common differentials of acute scrotal pain with swelling include causes such as torsion of the testis or its appendages, epididymoorchitis, testicular trauma, testicular tumours, cellulitis and Fournier gangrene. There are a few case reports describing the accumulation of a pancreatic fluid in the scrotum with the earliest being in 1979. Lin et al. described surgical exploration performed for suspected